While conversations around mental health have increased in recent years, the moment the word “suicide” is mentioned, the conversation stalls. Talking about suicide remains taboo in many parts of the world and across social circles, communities and even healthcare settings.
Our reluctance to have honest conversations with people experiencing suicidal thoughts is causing great harm and perpetuating the stigma. However, learning how to talk about suicide in a compassionate, respectful way has the power to save lives and dispel the myths and fears surrounding one of mental health’s darkest and most difficult topics.
Why are we so afraid to say the word suicide?
Most of us are afraid of saying the wrong thing, worried about upsetting someone, making the situation worse or asking a question we’re not ready (or equipped) to deal with.
There are also multiple layers of stigma surrounding suicide to unravel, including cultural and religious beliefs, shame, fear, and misunderstanding. All of these factors have made it something we don’t feel comfortable discussing openly.
In more than 20 countries, including the Bahamas, Kenya and the UAE, suicidal behaviour is still illegal. In others, suicide remains so heavily stigmatised that families may conceal it. This stigma is not limited to low- and middle-income countries, but is also prevalent in Western nations, including the USA and Europe.
The World Health Organization (WHO) acknowledges stigma and taboo as significant obstacles to suicide prevention, preventing some people experiencing suicidal thoughts from seeking the help they need.
Not saying the word or talking about it doesn’t make suicide disappear. It just leaves a vulnerable person alone to struggle with their thoughts rather than getting the help they need.
Suicide by the numbers
We don’t talk openly about it, yet more than 720,000 people die by suicide every year.
For every suicide, there are estimated to be more than 20 suicide attempts.
Suicide is the third leading cause of death among 15–29-year-olds; however, suicide can happen at any stage of life. In fact, 44% of suicide deaths worldwide occur among people aged 50 and over.
Suicide is also not predominantly a problem of wealthy Western countries. Almost three-quarters (73%) of global suicides occur in low- and middle-income countries.
Those numbers are worth opening up the conversation.
Because behind every one of those numbers is a real person — families, partners, children, parents, friends and communities — whose lives are forever changed.
What does it mean to feel suicidal?
One reason suicide can be so difficult to talk about is that we tend to think about it in absolutes.
Someone either wants to live or wants to die. But suicidal thoughts can be far more complicated.
For some people, it may begin with thoughts about wanting to escape from life. Maybe they fantasise about going to sleep and never waking up, or they find themselves increasingly indifferent about whether they live or die.
Others may experience persistent suicidal thoughts or begin thinking more actively about ending their life.
Sometimes, it isn’t necessarily that someone wants to end their life. They just want the unbearable pain to end.
When someone can’t imagine their circumstances changing or a way out of their emotional pain, suicide might start to feel like the only way to make it all stop and go away forever.
You don’t have to look suicidal to feel suicidal
Most of us have ideas and stereotypes about what someone experiencing suicidal thoughts is supposed to look like.
Visibly depressed.
Withdrawn.
Missing work.
Unable to function.
Never leaves the house.
It’s true that sometimes there are noticeable signs that somebody is struggling. But for those who have spent years hiding and protecting their emotions, they can become remarkably skilled at masking and fooling everyone around them. From the outside, they appear to be coping quite well.
This can be particularly true for someone who grew up in an environment where vulnerability wasn’t safe or who learnt early in life that difficult emotions should be suppressed and hidden rather than shared. Nobody knows about the conversations happening inside their head because they’ve never felt safe enough to share it with anyone else.
We have all heard someone say after the fact, “We had no idea. They seemed perfectly fine!” Unfortunately, high-functioning doesn’t necessarily mean being emotionally healthy.
Why does someone become suicidal?
This is the most difficult question, because there isn’t one answer.
The WHO describes suicide as multifaceted, influenced by a combination of social, cultural, biological, psychological and environmental factors throughout a person’s life.
Depression and alcohol use disorders are associated with suicide, but not everybody who experiences suicidal thoughts has a diagnosed addiction or mental health condition.
Sometimes there is an identifiable crisis, but other times, there’s no one defining event but rather years of accumulated trauma, pain and stress.
Most people don’t suddenly fall apart. They struggle for a very long time. Often with no one ever knowing.
Does talking about suicide make it worse?
This is one of the most persistent and potentially harmful myths surrounding suicide, as we may worry that asking someone directly whether they’re thinking about suicide will put the idea into their head.
It doesn’t, and it won’t. If they are thinking about it, those thoughts are there regardless of what we say.
The WHO specifically advises that asking someone directly about suicidal thoughts does not provoke suicide. In fact, opening the conversation can help someone feel understood and give them an opportunity to talk about what they are experiencing.
Let’s break the silence.
How do you talk to someone about suicide?
You don’t need to worry about having the perfect words, and you don’t need to be a therapist to ask someone how they feel and if they are OK.
If you are concerned about someone, find a private place and give them your full attention. Tell them what you’ve noticed and ask how they’re feeling. And if you’re worried they may be suicidal, ask directly.
“I’m worried about you. Are you thinking about suicide?”
Then listen. Openly and without shame, judgement or advice. You don’t need to reassure, fix, judge or explain away what they’re feeling. You don’t have to understand why their life feels unbearable in order to believe them.
Now is not the time to say things like:
“But you have so much to live for”
“Think about your family/kids”
“Things could be so much worse, you have a pretty good life”
These statements may be well-intentioned, but they can end up making someone feel even more alone, misunderstood, and even guilty. You don’t want them to shut down, so give them room to simply tell you what is happening.
And do not promise absolute secrecy if someone tells you they intend to hurt themselves. If you believe someone is in immediate danger, stay with them and seek urgent professional or emergency support.
Let’s normalise talking about suicide
Suicide is difficult to talk about.
But avoiding the topic doesn’t make suicidal thoughts disappear. It just makes it harder to share.
We don’t need perfect words or to understand exactly how another person feels.
We just need to be willing to start the conversation so we can normalise talking about suicide.
World Suicide Prevention Day is 10 September. If you or someone you know is experiencing suicidal thoughts or may be in immediate danger, contact local emergency services or a suicide/crisis service in your country. Do not leave someone alone if you believe they are in immediate danger.